The way to control the interventricular septum thickness during septal myectomy. An experimental study

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Abstract

Background: At present, there are no methods for intraoperative monitoring of the interventricular septum (IVS) thickness in a stopped and empty heart. This might be an obvious reason for unsatisfactory results after a number of septal myectomies.

Aim: To provide an experimental background for the method to control the IVS thickness (that we had proposed) during septal myectomy.

Materials and methods: The proposed technique is based on the transillumination method. The experimental models were cadaveric porcine hearts, as well as fragments of the human myocardium removed during septal myectomies. The thickness of the translucent myocardium was estimated depending on the local illumination value at the entrance to the myocardium and the external illumination of the surgical field. We compared the results of 67 septal myectomies performed in the clinic of the Almazov National Medical Research Centre with the results of 35 similar experimental procedures with cadaveric porcine hearts using the proposed way of measurement.

Results: A graph of the illumination at the entrance to the myocardium against the thickness of the translucent myocardium was constructed. After conventionally performed septal myectomies the median variation of the myocardial thickness was 4 [3; 6] mm. In the experiment using the proposed control method, the median variation was 1 [1; 2] mm, i.e. significantly less than with the conventional approach (p = 3 x 10-10).

Conclusion: The method to control the IVS thickness when performing septal myectomy makes it possible to achieve the required myocardial thickness the resection area with much greater accuracy than with the conventional one.

About the authors

A. V. Gurshchenkov

Almazov National Medical Research Centre

Author for correspondence.
Email: glebenmerz@mail.ru
ORCID iD: 0000-0001-8494-0646

Aleksandr V. Gurshchenkov - MD, PhD, Assistant, Chair of Surgical Diseases’.

55-3 Mikrorayon 2, poselok im. Sverdlova, Vsevolozhskiy rayon, Leningradskaya oblast', 188683, Tel.: +7 (921) 799 36 34.

Russian Federation

M. V. Selivanov

Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0002-5210-6398

Maksim V. Selivanov - MD, Cardiac Surgeon’.

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

E. A. Mukhin

Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0002-1041-531X

Evgeniy A. Mukhin - Engineer’.

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

I. V. Sukhova

Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0002-7313-5307

Irina V. Sukhova - MD, PhD, Cardiologist, Leading Research Fellow.

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

Ya. A. D'yachenko

Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0003-2777-8739

Yakov A. D'yachenko - MD, Cardiac Surgeon, Postgraduate Student.

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

R. S. Agaev

Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0001-9258-9649

Ramil S. Agaev - MD, Cardiac Surgeon, Postgraduate Student.

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

A. D. Maystrenko

Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0003-0335-4712

Aleksey D. Maystrenko - MD, PhD, Cardiac Surgeon.

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

V. K. Novikov

Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0002-4311-3086

Vladimir K. Novikov - MD, PhD, Professor, Chair of Surgical Diseases.

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

V. S. Kucherenko

Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0001-5493-5205

Vladimir S. Kucherenko - MD, PhD, Professor, Chair of Surgical Diseases.

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

M. L. Gordeev

Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0001-5362-3226

Mikhail L. Gordeev - MD, PhD, Professor, Head of the Chair of Surgical Diseases.

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

References

  1. Hang D, Nguyen A, Schaff HV. Surgical treatment for hypertrophic cardiomyopathy: a historical perspective. Ann Cardiothorac Surg. 2017;6(4):318-28. doi: 10.21037/acs.2017.04.03.
  2. Morrow AG, Reitz BA, Epstein SE, Henry WL, Conkle DM, Itscoitz SB, Redwood DR. Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients. Circulation. 1975;52(1):88-102. doi: 10.1161/01.cir.52.1.88.
  3. Messmer BJ. Extended myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg. 1994;58(2):575-7. doi: 10.1016/0003-4975(94)92268-3.
  4. Borisov KV. Right ventricle myectomy. Ann Cardiothorac Surg. 2017;6(4):402-9. doi: 10.21037/acs.2017.07.10.
  5. Wehman B, Ghoreishi M, Foster N, Wang L, D'Ambra MN, Maassel N, Maghami S, Quinn R, Dawood M, Fisher S, Gammie JS. Transmitral septal myectomy for hypertrophic obstructive cardiomyopathy. AnnThorac Surg. 2018;105(4): 1102-8. doi: 10.1016/j.athoracsur.2017.10.045.
  6. Quintana E, Schaff HV, Dearani JA. Transapical myectomy for septal hypertrophy not accessible through the aortic root. World J Pediatr Congenit Heart Surg. 2015;6(3):455-7. doi: 10.1177/2150135115589791.
  7. Kim JH. Tips for Successful Septal Myectomy in Patients with Hypertrophic Cardiomyopathy. Korean J Thorac Cardiovasc Surg. 2018;51(3): 227-30. doi: 10.5090/kjtcs.2018.51.3.227.
  8. Khalpey Z, Korovin L, Chitwood WR Jr, Poston R. Robot-assisted septal myectomy for hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg. 2014;147(5):1708-9. doi: 10.1016/j.jtcvs.2013.12.017.
  9. Musharbash FN, Schill MR, Henn MC, Dami-ano RJ Jr. Minimally invasive septal myectomy for hypertrophic obstructive cardiomyopathy. Innovations (Phila). 2017;12(6):489-92. doi: 10.1097/IMI.0000000000000421.
  10. Smedira NG, Lytle BW, Lever HM, Rajeswaran J, Krishnaswamy G, Kaple RK, Dolney DO, Black-stone EH. Current effectiveness and risks of isolated septal myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg. 2008;85(1):127-33. doi: 10.1016/j.athoracsur.2007.07.063.
  11. Altarabsheh SE, Dearani JA, Burkhart HM, Schaff HV, Deo SV, Eidem BW, Ommen SR, Li Z, Ackerman MJ. Outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in children and young adults. Ann Thorac Surg. 2013;95(2):663-9. doi: 10.1016/j.athoracsur.2012.08.011.
  12. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733-79. doi: 10.1093/eurheartj/ehu284.
  13. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(24):e783-831. doi: 10.1161/CIR.0b013e318223e2bd.

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Copyright (c) 2019 Gurshchenkov A.V., Selivanov M.V., Mukhin E.A., Sukhova I.V., D'yachenko Y.A., Agaev R.S., Maystrenko A.D., Novikov V.K., Kucherenko V.S., Gordeev M.L.

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